Coronavirus, inequality, and access to the SUS: where the most vulnerable live

The COVID-19 pandemic has caused a rapid increase in hospitalizations for severe acute respiratory syndrome (SARS) in Brazil, and is expected to severely strain the capacity of the Unified Health System (SUS). Major cities already have confirmed cases among socially vulnerable populations. In this context, it is crucial for healthcare planning to identify where socially vulnerable groups with limited access to the SUS live, and which healthcare facilities are likely to face the most severe bottlenecks in meeting the demand for hospitalizing critically ill patients.

To contribute to this discussion, Ipea and ITDP Brasil have published a Technical Note aimed at estimating how many vulnerable people (low-income and over 50 years old) live in Brazil's twenty largest cities and face the greatest difficulties accessing healthcare facilities. The study also provides estimates of the number of adult ICU beds and ventilators per capita within the catchment area of each hospital.

Among the study's findings, approximately 230,000 people in Brazil's twenty largest cities live more than a 30-minute walk from a healthcare facility capable of screening and referring suspected COVID-19 patients. Furthermore, in these same municipalities, about 1.6 million people live more than 5 km by car from a hospital with the capacity to admit critically ill patients to the ICU.

Another key finding concerns the number of ICUs capable of meeting the demands generated by the disease. The average number of adult ICU beds with mechanical ventilators is 1.11 per 10,000 inhabitants—a figure close to the recommended minimum under normal circumstances, but one that could be considered insufficient during a severe epidemic. The availability of beds per capita tends to be considerably lower on the outskirts of large cities, where a combination of factors—such as low income, urban density, and poor sanitation—raises alarms regarding the spread of COVID-19 and the limited capacity of the healthcare system.

Read the full technical note here.